347 Detecting Occult Shock in Trauma Patients: A Comparison of Serum Lactate versus Shock Index

Abstract

and mapped using shapefiles to verify lane/path availability. We used spatial analysis to identify statistically significant clusters of high and low ISS. We selected a-priori two motor vehicle traffic and bicyclist dense roads (First and Second Avenues) with recently installed bicycle routes to compare the distribution of ISS for events occurring prior to and after installation. Results: After screening for eligibility, 839 patients qualified for inclusion. In the period prior to installation of bike lanes and protected paths, 21 bicyclist versus motor vehicle incidents occurred on First and Second Avenues; all were mildly severe. In the period after installation, 45 incidents occurred including 6 moderately injured, 1 severely injured, and 1 critically injured. Multivariable ordinal logistic regression modeling revealed that, holding all other variables constant, bike lane availability was associated with nearly 70% increased log odds of a bicyclist having a more severe injury (ie, moving up one level in ISS categories) compared to having no lane or path available (AOR 1.70 95% CI 1.08-2.67). There was no difference in the log odds of having a more severe injury when protected paths were available (AOR 1.27 95% CI 0.67-2.41). Conclusion: Installation of demarcated bike lanes was associated with an increase in severe injuries among bicyclists presenting to our NYC trauma center. Installation of protected paths was not associated with significant differences in injury severity. These results may be due to increased bicycle rider volumes and speeds. Additional exposure data are necessary to fully characterize the impact of bike lanes and protected paths on injury severity.

Biomarker-Based Assessment Model for Detecting Sepsis: A Retrospective Cohort Study

“…Lactate is known to be increased as a result of anaerobic glycolysis due to inadequate oxygen delivery in septic shock [ 28 , 29 ]. Several studies have shown that the lactate level is more sensitive to tissue hypoxia compared to other parameters, and it is associated with higher mortality if not normalized by treatment [ 30 , 31 , 32 , 33 ]. Therefore, lactate was also used in our model to complement the concealed hypoxic changes through sepsis.…”